vascular questions

Question 1

A 65-year-old man is diagnosed with an abdominal aortic aneurysm with a diameter of 3.9 cm through the national screening programme. He is scanned again the following year to monitor the aneurysm and the diameter is now measured as 5.1 cm. He has no symptoms from his aneurysm at the present time.

What is the most appropriate next step in the management of this man’s aneurysm?

urgent open repair
urgent EVAR
elective EVAR

Answer 1

elective EVAR

Rapidly enlarging aneurysms of any size should be repaired even if asymptomatic
The aneurysm has enlarged by 1.2 cm in a year, meaning it fits the criteria for being ‘rapidly enlarging’. Such aneurysms have a higher rate of rupture even if they are of a diameter less than 5.5 cm (the usual cut off for surgery). He is not symptomatic so there is no risk of imminent rupture so urgent surgery is not necessary, but he should be offered an elective repair